Impact of brain atrophy on 90-day functional outcome after moderate-volume basal ganglia hemorrhage

Abstract

This study aimed to evaluate the effect of brain atrophy on the functional outcome of patients with moderate-volume basal ganglia hemorrhage. Of 1003 patients with spontaneous intracerebral hemorrhage, 124 with moderate-volume basal ganglia hemorrhage (hematoma volume of 20-50 mL) were enrolled. The intercaudate distance (ICD) and sylvian fissure ratio (SFR) were used as linear brain atrophy parameters. The patients were divided into groups with favorable and unfavorable outcomes, according to the Glasgow Outcome Scale score, 90 days after symptom onset. Demographic and radiographic features, including the ICD and SFR, were compared between the two groups. Among the 124 patients, 74 (59.7%) exhibited a favorable outcome. The ICD and SFR values were significantly greater for the favorable group than for the unfavorable group. Multivariate analysis indicated that young age, high Glasgow Coma Scale score at admission, small hematoma volume, and increased ICD (odds ratio [OR], 1.207; 95% confidence interval [CI], 1.004-1.451) and SFR (OR, 1.046; 95% CI, 1.007-1.086, per 0.001) values had a beneficial effect on functional outcome. In conclusion, brain atrophy exhibits protective effects in patients with moderate-volume basal ganglia hemorrhage, and is an important factor for predicting functional outcome.

Figure 1

The intercaudate distance (ICD) and sylvian fissure ratio (SFR) as linear brain atrophy parameters. (A) Schematic figure showing the classic measurement technique for the ICD (a) and SFR [(b1 + b2)/2c]. The figure is adapted by permission from Jinsoo Rhu, the copyright holder. (B and C) Linear measurements from computed tomography images. The ICD is estimated by initial measurement of the hemi-ICD on the unaffected side and multiplication of the derived value by 2. For measurement of the SFR, the maximal width of the sylvian fissure on the unaffected side is divided by the transpineal inner table diameter.

Figure 2

Clinical and radiological features of the atrophy and non-atrophy groups. (A) Scatterplot showing an increase in the intercaudate distance (ICD) with advancing age. The dotted line represents the Loess (locally weighted scatterplot smoothing) curve, and the shaded bands around the curve indicate 95% confidence limits. (B) Relationship between the hematoma volume and midline shift. (C) Distribution of the Glasgow Coma Scale (GCS) scores at admission for the two groups. (D) Treatment modalities for the two groups.